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NICE anxiety disorder and panic disorder guideline

Generalised anxiety disorder and panic disorder in adults: management

Key priorities for implementation

The key priorities for implementation have been chosen from the updated recommendations on the management of generalised anxiety disorder (GAD)

Step 1: All known and suspected presentations of GAD

Identification

identify and communicate the diagnosis of GAD as early as possible to help people understand the disorder and start effective treatment promptly

consider the diagnosis of GAD in people presenting with anxiety or significant worry, and in people who attend primary care frequently who:

have a chronic physical health problem or

do not have a physical health problem but are seeking reassurance about somatic symptoms (particularly older people and people from minority ethnic groups) or

are repeatedly worrying about a wide range of different issues

Step 2: Diagnosed GAD that has not improved after step 1 interventions

Low-intensity psychological interventions for GAD

for people with GAD whose symptoms have not improved after education and active monitoring in step 1, offer one or more of the following as a first-line intervention, guided by the person's preference:

individual non-facilitated self-help

individual guided self-help

psychoeducational groups

Step 3: GAD with marked functional impairment or that has not improved after step 2 interventions

Treatment options

for people with GAD and marked functional impairment, or those whose symptoms have not responded adequately to step 2 interventions:

offer either:

an individual high-intensity psychological intervention or

drug treatment

provide verbal and written information on the likely benefits and disadvantages of each mode of treatment, including the tendency of drug treatments to be associated with side effects and withdrawal syndromes

base the choice of treatment on the person's preference as there is no evidence that either mode of treatment (individual high-intensity psychological intervention or drug treatment) is better

High-intensity psychological interventions

if a person with GAD chooses a high-intensity psychological intervention, offer either cognitive behavioural therapy (CBT) or applied relaxation

consider offering sertraline first because it is the most cost-effective drug, but note that at the time of publication (January 2011) sertraline did not have UK marketing authorisation for this indication. Informed consent should be obtained and documented. Monitor the person carefully for adverse reactions

do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the British National Formulary on the use of a benzodiazepine in this context

do not offer an antipsychotic for the treatment of GAD in primary care

Inadequate response to step 3 interventions

consider referral to step 4 if the person with GAD has severe anxiety with marked functional impairment in conjunction with:

NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review and may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product/publication.

Disclaimer: This guide for healthcare professionals on identifying medical comorbidities in autism spectrum disorders has been developed by Treating Autism.
Source: Treating Autism (www.treatingautism.org.uk/wp-content/uploads/2016/11/comorbidities_guide_4p.pdf). Date of preparation: October